Exam 1 Review Questions Flashcards
Which of the following statements best defines the term culture?
a) The learned patterns of behavior, beliefs, and values that can be attributed to a particular group of people
b) The classification of a group based upon certain distinctive characteristics
c) The status of belonging to a particular region by origin, birth, or naturalization
d) A group of people distinguished by genetically transmitted material
a) The learned patterns of behavior, beliefs, and values that can be attributed to a particular group of people
Rationale: Included among characteristics that distinguish cultural groups are manner of dress, values, artifacts, and health beliefs and practices. A group of people distinguished by genetically transmitted material describes the term race. The status of belonging to a particular region by origin, birth, or naturalization describes the term nationality. The classification of a group based upon certain distinctive characteristics describes the term ethnicity.
A 54-year-old woman on a fixed income has had an electrocardiogram (ECG) as part of her annual physical examination. Her physician notes an abnormal Q wave on an otherwise unremarkable ECG. What legislation supports this focus on disease prevention, health promotion, and management of chronic conditions?
a) Building a Safer Health System Act
b) The Patient Protection and Affordable Care Act
c) Healthcare Research and Quality Improvement Bill
d) A New Health System for the 21st Century Bill
b) The Patient Protection and Affordable Care Act
Rationale: The Patient Protection and Affordable Care Act, also known as the ACA, supports access to quality, affordable health care, improved access to innovative and preventive health care programs and therapies, and expanded insurance coverage. “To Err Is Human: Building a Safer Health System” and “Crossing the Quality Chasm: A New Health System for the 21st Century” are IOM reports. Centers for Medicare and Medicaid Services (CMS) partnered with the Agency for Healthcare Research and Quality (AHRQ) to launch the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey.
Which of the following would be included as a goal of case management?
a) Utilization of the nursing process
b) Prescriptive authority
c) Appropriateness of services
d) Attainment of fixed-price reimbursement
c) Appropriateness of services
Rationale: The goals of care management are quality, appropriateness, and timeliness of services as well as cost reduction. Case managers do not have prescriptive authority. Fixed-price reimbursement is a feature of managed care. Case managers do not use the nursing process.
According to Hood and Leddy (2007), which of the following are components of wellness?
a) Inability to obtain personal goals
b) Expression of disharmony
c) Feelings of well-being
d) Inability to adapt to changing situations
c) Feelings of well-being
Rationale: Hood and Leddy (2007) consider that wellness is a reported feeling of well-being and a feeling that “everything is together.” They also believe wellness is a person’s capacity to perform to the best of his or her ability. Wellness is also comprised of the ability to adjust and adapt to varying situations.
The school nurse informs the mother of a second-grade student that she found lice in her child’s hair. The mother explains to the nurse that she has another child to pick up and cannot stay to receive education related to the treatment of lice at this time. The mother reassures the nurse that she will “look up treatment options on the Internet and take care of the child.” What would be the best action of the school nurse in this situation?
a) Instruct the mother to treat the other child for lice in the same manner as the second grade child
b) Provide the mother with a list of credible Web sites related to the treatment of lice
c) Notify the social worker of suspected child neglect and make a referral to child protective services
d) Perform hand hygiene and notify the second-grade teacher to wash down the classroom
b) Provide the mother with a list of credible Web sites related to the treatment of lice
Rationale: Providing the mother with a list of previewed Web sites related to treating lice assist the mother to receive trustworthy, credible, and timely information related to treatment options. Although assessing and treating the other children in the home is indicated, it is more important to direct the mother to accurate information related to the treatment of lice. The nurse should perform routine hand hygiene, washing the classroom is not indicated. The presence of lice does not warrant a referral to the social worker or child protective services.
In which of the following situations is the nurse demonstrating the ethical principle of beneficence?
a) Providing truthful and accurate information to a patient about a procedure
b) Volunteering to provide vaccinations at the local health center
c) Ensuring adequate staffing to provide care to all patients
d) Refusing to give an ordered medication based on assessment findings
b) Volunteering to provide vaccinations at the local health center
Rationale: Beneficence is the duty to do good and the active promotion of benevolent acts. Fidelity refers to the duty to be faithful to one’s commitments. Veracity is the obligation to tell the truth. Nonmaleficence is the duty not to inflict, as well as to prevent and remove, harm; it is more binding than beneficence.
What percentage of people older than 65 years of age has one or more chronic disease?
a) 50
b) 80
c) 70
d) 60
b) 80
Rationale: Eighty percent of people older than 65 years of age have one or more chronic illness and many are limited in their activity
Which of the following nursing actions demonstrates that the nurse understands the nursing process?
a) Prioritizing patient goals, documenting all health records precisely, conducting the health history, and documenting the nursing diagnosis
b) Reviewing health record, documenting patient goals, identifying etiology of the nursing problem, and evaluating treatment outcome.
c) Assessing for allergies, administering analgesic, obtaining baseline vital signs, and documenting nursing diagnosis as acute pain
d) Obtaining vital signs, documenting nursing diagnosis as acute pain, administering analgesic, and evaluating comfort level
d) Obtaining vital signs, documenting nursing diagnosis as acute pain, administering analgesic, and evaluating comfort level
Rationale: Steps of the nursing process in order are: Assessment, Diagnosis, Planning, Implementation, and Evaluation. Assessment is the systematic collection of data to determine the patient’s health status and any actual or potential health problems. Nursing diagnoses are actual or potential health problems that can be managed by independent nursing interventions. Planning is the development of goals and outcomes. Implementation is the actualization of the plan of care through nursing interventions. Evaluation is the determination of the patient’s responses to the nursing interventions and the extent to which the outcomes have been achieved.
The nurse educator is planning a teaching session for nursing students related to treatment and management of gestational diabetes. The nurse educator arranges for a dietitian, pharmacist, and physician assistant to participate in the lesson plan. Which professional nurse competency is the nurse educator demonstrating?
a) Evidence-based practice
b) Patient-centered care
c) Interdisciplinary teamwork
d) Quality improvement measures
c) Interdisciplinary teamwork
Rationale: By integrating interdisciplinary core competencies into their respective curricula the nurse educator is demonstrating interdisciplinary teamwork. A case-study approach planning care around individual patient preferences is an example of patient-centered care. Conducting an evidence-based literature review related to gestational diabetes reflects evidence-based practice. Providing education related to measures/indicators or tools used to assess the level of care provided within a system of care to populations of patients with gestational diabetes exemplifies a quality improvement measure.
A nursing student observes the home care nurse provide education to a patient with congestive heart failure (CHF). The nurse teaches the patient how to read food labels and calculate sodium content. The nursing student recognizes that the home care nurse is aware of which of the following basic principles of patient education?
a) The home care nurse is providing hospital discharge instructions
b) The home care nurse has a physician order to teach a 2-g sodium diet
c) Patients are required to learn about their therapeutic nutritional regimen
d) Patient instruction related to self-care activities promotes patient independence
d) Patient instruction related to self-care activities promotes patient independence
Rationale: Teaching is a function of nursing to assist patients to alter lifestyle patterns that increase health risk. By teaching the client how to calculate sodium content of foods the nurse is facilitating independence in nutrition disease management. Patients have the right to decide whether or not to learn. Teaching is an independent function of nursing and does not require a physician’s order. Teaching related to food labels in the patient home is an appropriate environment for this client. The nurse can use actual foods from the patient’s kitchen.
A nurse working in the intensive care unit (ICU) refers to the Institute for Healthcare Improvement (IHI) Ventilator Bundle prior to planning patient care. The nurse realizes nursing interventions outlined in the bundle will improve patients’ outcomes. Which of the following statement best describes how IHI-established nursing interventions should be included in each bundle?
a) Nursing interventions found within the IHI bundles were selected based on the ability to provide optimal time management for the nurse
b) Best practice derived from valid and reliable research studies guided nursing interventions being added to the IHI bundles
c) Nurse case managers serving as patient advocates recommended nursing interventions to be included in the IHI bundles based on patient preference
d) Hospitals, physicians, and nurses worked collaboratively to design patient care activities included in IHI bundles
b) Best practice derived from valid and reliable research studies guided nursing interventions being added to the IHI bundles
Rationale: Bundles include evidence-based practices. Hospitals, physicians, and nurses work collaboratively to provide care directed by bundles. Nurses advocate on behalf of the patient. Effective time management is a key element in the provision of care, however; IHI-based bundles on evidence-based practice.
Which of the following examples of therapeutic communication techniques may occur during the planning stage and increases the patient’s perception of available options?
a) “Home health services are also available in our community if you feel an assisted living situation is uncomfortable.”
b) “You appear confused about assisted living facilities.”
c) “Let’s discuss specific concerns you have regarding assisted living facilities.”
d) “I hear you say that you are uncomfortable with the idea of going to an assisted living facility.”
a) “Home health services are also available in our community if you feel an assisted living situation is uncomfortable.”
Rationale: Suggesting is the presentation of alternative ideas such as home health services the patient’s consideration and increases the perception of other possible solutions relative to the problem. Clarification is asking the patient to explain what he or she means or attempting to help verbalize the patient’s vague ideas or unclear thoughts to enhance the nurse’s understanding. Focusing includes questions or statements to help the patient develop or expand an idea. Reflection directs back to the patient his feelings but does not increase the patient’s perception of available options.
The nurse caring for a HIV patient diagnosed with acute pneumonia demonstrates understanding of the nurse’s role in the current focus on management of chronic illness and disability in which of the following situations?
a) Reviewing the patient’s CD4 count
b) Making a referral to an HIV support group
c) Administering prescribed antibiotics
d) Teaching the patient to avoid crowds
d) Teaching the patient to avoid crowds
Rationale: Current focus on chronic disease conditions is focused on disease prevention. Teaching the patient to avoid crowds encourages the patient to take control of their health and reduce the risk of pneumonia exacerbations. Administering prescribed antibiotics is indicated in this situation; however, it does not promote independence in the patient. Making a referral to a HIV support group is indicated in this situation; however, the focus is on actions of the nurse not the patient. Reviewing the patient’s CD4 count is important but does not indicate the patient’s ability to control his or her health.
In which of the following actions is the nurse illustrating the step of the nursing process that determines if the patient understands the health teaching that is provided?
a) Setting short-term educational goals for the patient newly diagnosed with diabetes
b) Teaching injection sites to a patient newly diagnosed with diabetes
c) Watching a return demonstration of insulin administration from a newly diagnosed diabetic
d) Asking a new diabetic, “What are your questions about giving yourself an insulin injection?”
c) Watching a return demonstration of insulin administration from a newly diagnosed diabetic
Rationale: Evaluation includes observing the patient, asking questions, and then comparing the patient’s behavioral responses with the expected outcomes. Observation of a return demonstration is a form of evaluation. Assessment includes determining the patient’s readiness regarding learning. Planning includes identification of teaching strategies, writing the teaching plan, and setting goals of the teaching strategies. Implementation is the step during which the teaching plan is put into action.
During an interview for an ambulatory clinic position, the nurse notices that family planning counseling is included in the job description. Being a devout Catholic, how should the nurse proceed with the interview?
a) Continue the interview and only provide patients with information related to abstinence
b) Continue the interview; other nurses at the center can provide family counseling
c) Excuse herself from the interview stating she is Catholic
d) Realize the ethical obligation to provide care to all faiths, and continue the interview process
c) Excuse herself from the interview stating she is Catholic
Rationale: One strategy a nurse can use to avoid ethical dilemmas is to inquire about the patient population of potential employers. In this situation, being Catholic and providing counseling regarding family planning create an ethical dilemma for the nurse. It is appropriate for the nurse to avoid the dilemma based on this conflict of personal values. The delegation of a specific job duty by the nurse is not appropriate in this situation. Continuing the interview indicates the nurse is willing to meet job duties as described. Avoiding ethical dilemmas in providing patient care is priority. The nurse’s strong Catholic faith may interfere with her ability to provide patients with unbiased and objective information related to family planning options.
The physician asks the nurse not to disclose the patient’s diagnosis of end-stage cancer with the patient until the patient’s family can be available to provide support. During the nurse’s shift, the patient asks the nurse, “What is wrong with me? Everyone is treating me like I am dying.” Which of the following replies by the nurse allows the nurse to maintain integrity while providing care for the patient?
a) “Test results indicate that you are in the end-stages of your disease process.”
b) “I will call the chaplain to talk to you about your concerns.”
c) “You are fine; I hear your family will be in town soon.”
d) “You feel like people are treating you like you are dying?”
d) “You feel like people are treating you like you are dying?”
Rationale: By using the therapeutic communication, technique of restating the nurse demonstrates listening and validates the patients concerns allowing the nurse to maintain integrity. Calling the chaplain defers care of the patient to the clergy. Telling patients they are fine does not provide accurate information to the patients. Lying to the patient jeopardizes the nurse’s integrity and ability to develop a trusting relationship with the patient. Although information provided at the patient’s request protects the patient’s autonomy, it does not provide respect for others in this situation. Disclosure of sensitive information without compassion and caring may increase the impact and distress related to a poor diagnosis.
When providing discharge instructions, the nurse recognizes which of the following patients is most likely to comply with the therapeutic treatment regimen?
a) The pneumonia patient that requires 1 week of oral antibiotics
b) The newly diagnosed type 2 diabetic that requires nutritional counseling
c) The patient with a positive tuberculosis skin test requiring 9 months of isoniazid
d) The patient with kidney failure that requires hemodialysis
a) The pneumonia patient that requires 1 week of oral antibiotics
Rationale: Rates of adherence are generally low, especially when the regimens are complex or of long duration. One week of oral antibiotics has a higher likelihood of patient compliance. Nutritional education and compliance is long term and complex in nature; therefore, it has a high risk for noncompliance. The 9-month duration of isoniazid therapy places this in the high-risk category for noncompliance. Hemodialysis is long-term and complex in nature; therefore, it is high risk for noncompliance.
An advanced practice registered nurse (APRN) specializing in adult-gerontology has accepted a new position in a different state. Which governing body does the APRN need to consult to verify prescriptive authority in the new state?
a) The new employers’ board of directors
b) The new states boards of nursing
c) The new states APRN Advisory Committee
d) The National Council of State Boards of Nursing (NCSBN)
b) The new states boards of nursing
Rationale: Individual states have their own distinct state boards of nursing (and sometimes state boards of medicine) regulations that govern APRN practice. Individual states do not have APRN advisory committees. The APRN Consensus Model promotes a new APRN regulatory model that addresses the essential elements of APRN licensure, accreditation, certification, and education (LACE). The NCSBN provides state boards of nursing an organization allowing them to act and counsel together on matters of common interest related to the public health, safety and welfare, including the development of licensing examinations in nursing. The board of directors guides nursing care within the rules for nursing practice established by the State Board of Nursing.
Consuming which of the following is a strategy to enhance health as part of health promotion?
a) A diet rich in vitamin C
b) A diet rich in vitamin A
c) A diet rich in proteins
d) A diet rich in grains
The nurse is attending a patient with chronic renal failure. The patient says that of late, he has lost his appetite and feels like everyday situations have become more stressful. He reports feeling disappointed and frustrated with his condition, and says that he has not been of any help to his family. What is the most important nursing intervention that the nurse needs to carry out at this point?
a) Offer nutritional counseling
b) Administer drug therapy to restore renal functions
c) Coordinate with resources for client support
d) Administer immunosuppressant
c) Coordinate with resources for client support
Rationale: Promotion of psychological comfort is one of the most important aspects of the care of the patient with chronic renal failure. Coordination of resources for client support is an appropriate nursing intervention in this situation. Nutritional counseling, involving the family in the plan of care, and providing psychosocial support to the patient are all relevant nursing interventions that form a part of the nursing management process for a patient with chronic renal failure. Nutritional counseling, administration of drug therapy to restore renal functions, and administration of immunosuppressant drugs are medical management tasks.
The physician orders a nasogastric (NG) tube for a young adult diagnosed with end-stage ovarian cancer suspected of having a bowel obstruction. The newly hired nurse explains the procedure and rational for NG tube placement. The patient refuses to consent to NG tube placement stating “I would rather keep vomiting than to have the tube in my nose.” Following the American Nurses Association Code of Ethics for Nurses what should the nurse do next?
a) Make a referral to Social Services related to body-image disturbance
b) Call the patient’s husband so he can consent to the procedure
c) Document the patient’s wishes and notify the physician
d) Delegate the NG tube placement to a more experienced nurse
c) Document the patient’s wishes and notify the physician
Rationale: The American Nurses Association Code of Ethics for Nurses directs the nurse to advocates for, and strives to, protect rights of the patient. There is no indication that this patient is not able to make informed decisions related to her care. Referral to the social worker is not an appropriate nursing intervention for this patient. The patient has the right to refuse the procedure. Experience of the nurse does not make a difference in this situation. The nurse needs to be an advocate for the patient. The patient’s husband cannot make this decision for his wife while she is competent to make decisions for herself.
According to Maslow’s hierarchy of human needs, which of the following is the highest level of need(s)?
a) Belongingness
b) Safety and security
c) Physiological needs
d) Self-actualization
d) Self-actualization
Rationale: Maslow’s hierarchy of need shows how a person moves from fulfillment of basic needs to higher level of needs. The ultimate goal is integrated human functioning and health. Self-actualization is the highest level need. Safety and security, physiological needs, and belongingness are below this level of need.
Which of the following is an example of a direct measurement technique for evaluation of the teaching-learning process?
a) Instruments that evaluate specific health status variables
b) Patient satisfaction surveys
c) Attitude surveys
d) Behavioral observation
d) Behavioral observation
Rationale: Direct measurement techniques include behavioral observation, checklists, and anecdotal notes to document the behavior. Patient satisfaction surveys, attitude surveys, and oral questioning, and instruments that evaluate specific health status variables are indirect measurements.
Place the following nursing actions in sequence in the nursing process.
a) Identifying learning needs and etiology
b) Identifying alterations that need to be made to the teaching plan
c) Putting the teaching plan into action
d) Establishing expected outcomes
e) Determining what the patient wants to learn
The steps of the teaching/nursing process are assessment, diagnosis, planning, implementation, and evaluation.
Assessment in the teaching-learning process is directed toward the systematic collection of data about the person and family’s learning needs and readiness to learn.
A nursing diagnosis that relates specifically to a patient’s and family’s learning needs serves as a guide in the development of the teaching plan.
The expected outcomes, which identify the desired behavioral responses of the learner, are completed during the planning phase of the nursing process.
The implementation phase of the teaching-learning process, the patient, the family, and other members of the nursing and health care team carry out the activities outlined in the teaching plan.
The evaluation phase of the teaching-learning process is used to determine what was effective and what needs to be changed.
Which of the following is a traditional definition of nursing by American Nurses Association (ANA)?
a) Discussing what nurses would do for themselves if they had the necessary strength, will, or knowledge
b) Diagnosing and treating human responses to actual or potential health problems
c) Putting the patient in the best condition for nature to act upon him or her
d) Helping people to carry out activities contributing to health, recovery, or a peaceful death
b) Diagnosing and treating human responses to actual or potential health problems
Rationale: The ANA traditionally defined nursing as “the diagnosis and treatment of human responses to actual or potential health problems.” Florence Nightingale described the role of the nurse as putting “the patient in the best condition for nature to act upon him.” Virginia Henderson envisioned the role of a nurse as helping people (sick or healthy) to carry out the activities that contribute to their health, recovery, or a peaceful death as well as the activities that they would do for themselves if they had the necessary strength, will, or knowledge.
Which of the following patient statements indicates the patient’s experiential readiness to learn?
a) “Do you have a video about my disease? I don’t like to read.”
b) “Now that I am more comfortable, I am ready to learn about pain management techniques.”
c) “Can we take a minute to pray before learning about my treatment plan?”
d) “I understand that I have diabetes and will need to learn how to administer my daily insulin injections.”
a) “Do you have a video about my disease? I don’t like to read.”
Rationale: Experiential readiness refers to past experiences that influence a patient’s ability to learn. Emotional readiness refers to the patient’s acceptance of an existing illness or the threat of an illness and its influence on the ability to learn. Physical readiness refers to the patient’s ability to cope with physical problems and focus attention upon learning.
Based on the nurse’s knowledge of nonadherence to therapeutic regimens which of the following nurses needs to place extra emphasis on adherence to the treatment plan?
a) The nurse planning to teach teenagers about mononucleosis
b) The nurse planning to teach a group of children about healthy eating
c) The nurse planning to teach middle-aged adults about stress management
d) The nurse planning to teach adults age 65 about congestive heart failure (CHF) management
d) The nurse planning to teach adults age 65 about congestive heart failure (CHF) management
Rationale: Eighty percent of people older than 65 years of age have one or more chronic illness and many are limited in their activity. These chronic illnesses may be managed with numerous medications and complicated by periodic acute episodes, making adherence to a regimen difficult. Problems of teenagers, generally, are time limited and specific and require promoting adherence to treatment to return to health. In general, the compliance of children to a regimen depends on the compliance of their parents. Middle-aged adults, in general, have fewer health problems, thus promoting adherence to a regimen.
The acute care nurse practitioner planning care for a patient with rheumatoid arthritis reviews treatment guidelines developed by the American Nurses’ Association (ANA). Which of the following ANA documents is the nurse accessing?
a) Social Policy Statement
b) Code of Ethics
c) Nursing’s Standards of Practice
d) Standards of Professional Performance
d) Standards of Professional Performance
Rationale: Reviewing and integrating evidence and research findings into practice is included in the Standards of Professional Performance. The ANA Code of Ethics establishes nursing responsibilities and care-maintaining ethical obligations. Nursing’s Standards of Practice describe basic competencies in delivering nursing care using the nursing process. The ANA Social Policy Statement defines nursing’s value and accountability to society.
The nursing student over hears a patient talking with the rehabilitation nurse stating, “I plan to recover to the best of my ability after having a stroke. I know I will always have some limitations; however, I will not let the limitations slow me down.” Which description of health is the patient exemplifying in this situation?
a) Hood and Leddy’s definition of health
b) The concept of health wellness-illness continuum
c) The World Health Organization’s definition of health
d) The wellness promotion strategy of risk reduction
b) The concept of health wellness-illness continuum
Rationale: The concept of a health-illness continuum allows for a greater range in describing a person’s health than the definition provided by the WHO. On the health–illness continuum, even people with a chronic illness or disability may attain a high level of wellness if they are successful in meeting their health potential within the limits of their chronic illness or disability. The WHO definition does not allow for any variations in the degrees of wellness and illness. Hood and Leddy discuss wellness as having four components. Risk reduction is a strategy of health promotion.
A certified nurse practitioner (CNP) working in the emergency department (ED) provides advanced cardiac life support (ACLS) to a patient experiencing asystole. Immediately following Intravenous (IV) access the CNP knows the first medication to be administered is epinephrine. When the patient remains in asystole the nurse knows to administer atropine. Which care planning tool is the nurse using to provide patient care?
a) Bundles
b) Care map
c) Algorithm
d) Nursing care plan
c) Algorithm
Rationale: Algorithms are used in acute situations to determine treatment based on patient information or response to treatment. Nursing care plans utilize the nursing process (assessment, analysis, planning, implementation, and evaluation) to direct nursing care. Care maps along with clinical guidelines, and multidisciplinary action plans (MAPs) facilitate coordination of care and education throughout hospitalization and after discharge. Bundles are set of three to five evidence-based practices used to improve patient outcomes.
Which of the following situations would be appropriate for ethic committee review? Select all that apply.
a) Patient refusal of a lifesaving blood transfusion related to religious preference
b) Restraining a patient, after all other viable options have been exhausted
c) Request to administer fertilization injections to an infertile couple
d) Institutional participation in gene chip technology directed at disease prevention
e) Placing a 21-year-old cystic fibrosis patient on the double lung transplant list
a) Patient refusal of a lifesaving blood transfusion related to religious preference, d) Institutional participation in gene chip technology directed at disease prevention, e) Placing a 21-year-old cystic fibrosis patient on the double lung transplant list
Rationale: Dilemmas that center on death and dying are prevalent in medical-surgical nursing practice. Allocation of organs to patients with an otherwise poor prognosis is an appropriate ethical issue for an ethics review committee. Advances in genetics and genetic testing provide controversial ethical dilemmas such as gene chip technology. Administering fertilization injections to infertile couples is an accepted medical intervention. The American Nurses Association (ANA) advocates for the placement of restraints “only when no other viable option is available.” The Joint Commission and the Centers for Medicare and Medicaid Services (CMS) have published standards on the use of restraints.
Which of the following is a formal systematic study of moral beliefs?
a) Fidelity
b) Veracity
c) Ethics
d) Morality
c) Ethics
Rationale: Ethics is the formal, systematic study of moral beliefs. Veracity is the obligation to tell the truth and not to lie or deceive others. Fidelity is promise keeping. Morality is the adherence to informal personal values.
Which of the following is at the center of the process of clinical reasoning and clinical judgment?
a) Basic problem solving
b) Research
c) Critical thinking
d) Use of opinions to evaluate situations
c) Critical thinking
Rationale: The center of the process of clinical reasoning and clinical judgment is critical thinking. Critical thinking goes beyond basic problem solving into a realm of inquisitive exploration. Critical thinkers validate the information presented to make sure that it is accurate (not just supposition or opinion).
Which of the following statements accurately describes the clinical nurse leader (CNL)? Select all that apply.
a) Works in the acute care setting
b) Provides nursing care in community health settings
c) Delegates task to other health care personnel
d) Oversees fragmented care delivery
e) Manages care at the point of care
f) Educated at the master’s level in nursing
a) Works in the acute care setting, b) Provides nursing care in community health settings, c) Delegates task to other health care personnel, e) Manages care at the point of care, f) Educated at the master’s level in nursing
Rationale: The clinical nurse leader (CNL) must have earned a minimal degree in nursing at the master’s level, can work in acute care as well as community-based settings, and provides point-of-care case management. It is within the scope of practice for the CNL to delegate tasks to health care personnel outside of nursing. The CNL is accountable for improving individual care outcomes and processes in a quality, cost-effective manner, therefore reducing the occurrence of fragmented patient care.
Which step of the nursing process entails analyzing data related to the patient’s health status?
a) Evaluation
b) Diagnosis
c) Assessment
d) Implementation
c) Assessment
Rationale: Analysis of data is included as part of the assessment. Diagnosis is the identification of patient problems. Implementation is the actualization of the plan of care through nursing interventions. Evaluation is the determination of the patient’s responses to the nursing interventions and the extent to which the outcomes have been achieved.
A nurse asks a chronic obstructive pulmonary disease (COPD) patient to breathe in slowly through the nose, taking in a normal breath. Then, she asks the patient to pucker his lips as if preparing to whistle. Finally, she asks him to exhale slowly and gently through the puckered lips. The nurse recognizes that teaching the patient pursed-lip breathing helps the patient relax and gain control of dyspnea, reducing the feelings of panic they experience. Which of the ANA tenets characteristic of all nursing practice is the nurse demonstrating? Select all that apply.
a) Interdisciplinary collaboration
b) Individualized nursing practice
c) Establishment of a professional work environment
d) Evidence-based nursing
e) Using the nursing process
f) Caring
Correct Response: b) Individualized nursing practice, e) Using the nursing process, f) Caring
Rationale: Teaching pursed-lip breathing to a patient with COPD is individualized based on the patient’s diagnosis. The nurse demonstrates caring by providing education to support desired patient outcomes. The nurse uses the nursing process of assessment and analysis to determine the need to teach the client pursed-lip breathing. The nurse’s actions do not indicate work place environment changes or interdisciplinary collaboration. Evidence-based nursing is not an ANA tenet characteristic of all nursing practice.
A 75-year-old woman had surgery for her hip fracture yesterday. She is under stress due to pain, sleep deprivation, and hospital surroundings. The nurse caring for her implements a proactive approach to pain management. Plans include frequent communication to establish an acceptable pain rating, conducting hourly pain assessments, and hourly evaluation of the patient’s pain control. In addition to improved patient outcomes, how else might the hospital benefit from the nurse’s actions?
a) Continued accreditation from The Joint Commission
b) Additional funding from the Institute for Healthcare Improvement (IHI)
c) Improved Quality and Safety Education for Nurses (QSEN) survey scores
d) Improved Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey scores
d) Improved Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey scores
Rationale: HCAHPS survey measure patients’ satisfaction with the quality of the nursing care they receive, including their satisfaction with their communication with the nurses, the responsiveness of the hospital staff, the quietness of the environment, their pain management, communication about their medications, and their discharge information. Institute for Healthcare Improvement (IHI) is a nonprofit organization whose mission is adapted from the IOM’s six aims for improvement. IHI is not a funding source for hospitals. Accreditation from The Joint Commission has a larger scope outside of pain management measures. QSEN prepares future nurses with the knowledge, skills, and attitudes (KSA) required to continuously improving the quality and safety of the health care system.
A patient with HIV is visiting the health care center for a regular checkup. His symptoms indicate multiorgan infections and he reports extreme weakness and says that he is depressed most of the time, as his friends and colleagues has distanced themselves from him. Which are the primary areas of concern for the nurse attending the patient? Select all that apply.
a) Instruct the patient to take frequent rest periods.
b) Refer patient to seek psychosocial counseling.
c) Provide patient education related to multiorgan infections.
d) Diagnose opportunistic infections.
e) Prescribe medications based on viral load.
a) Instruct the patient to take frequent rest periods., b) Refer patient to seek psychosocial counseling., c) Provide patient education related to multiorgan infections.
Rationale: Independent HIV nursing management involves managing the patient’s psychosocial and educational needs. Diagnosis of opportunistic infections and medication prescription based on viral load are areas of interdependent concerns in disease management.
A patient and his wife are in his hospital room. The wife says to the nurse, “I looked up one of the new drugs he is taking on the Internet, gabapentin. It said it is for seizures. My husband has never had a seizure.” A therapeutic response by the nurse would be which of the following?
a) “Why are you asking? Your husband’s physician has probably told him the reason.”
b) “I will get you a current drug handbook; you can look it up.”
c) “I cannot discuss the drugs which the physician has ordered. You need to call her to ask that question.”
d) “Gabapentin or Neurontin can also be used for leg pain associated with diabetes.”
d) “Gabapentin or Neurontin can also be used for leg pain associated with diabetes.”
Rationale: The therapeutic response for the nurse is to provide education related to the patient’s wife’s question. By providing education the nurse is facilitating informed decision making on part of the patient and his family. Teaching is an independent function of the nurse. It is certainly within the responsibility of the nurse to discuss the method of action of the patient’s medications with the wife. This is part of patient teaching and if the husband is aware, it is not a HIPAA violation.
While collecting assessment information for a patient in labor, the nurse learns that the patient’s surgical history includes an elective abortion prior to meeting her husband. The patient asks the nurse not to tell her husband about the previous abortion. Faced with the moral uncertainty, how should the nurse proceed?
a) Encourage the patient to share this information with her husband
b) Uphold the patient’s wishes, ensuring patient confidentiality
c) Do not include this information in the patient’s electronic health record
d) Consult with an experienced staff nurse on how to proceed
b) Uphold the patient’s wishes, ensuring patient confidentiality
Rationale: Information related to the patient’s past medical history is not significant in providing care to the patient in this situation. The Health Insurance Portability and Accountability Act (HIPAA) provides for the maintenance of patient confidentiality. There is no medical reason for the patient’s past medical history to be revealed at this time. The patient has the right to decide when and if her past medical history needs to be shared with her husband. Documentation of all past medical history in the electronic health record is appropriate. Consultation with a nurse not assigned to the patient violates patient confidentiality. The level of experience of the nurse is not pertinent.
A nurse working in an acute care setting volunteers to participate in a research study. The nurse understands that research findings add to the scientific base of nursing practice. Evidence-based practice (EBP) accomplishes which of the following? Select all that apply.
a) Decrease health care cost
b) Provides answers to ethical questions
c) Delineate the health-illness continuum
d) Improve patient outcomes
e) Establish best nursing practices
f) Validate nursing diagnosis
a) Decrease health care cost, d) Improve patient outcomes, e) Establish best nursing practices
Rationale: EBP are developed from valid and reliable research studies that improve patient outcomes, establish best nursing practice, and decrease health care cost through decreased readmission and shortened lengths of stay. EBP does not validate nursing diagnosis. The health-illness continuum is used to describe a person’s health status; EBP does not delineate the health-illness continuum. Information from EBP may be used to gather information to increase one’s knowledge related to ethical issues; however EBP would be only one aspect in the answering of ethical questions.
During a teaching session with a patient with a new walker the nurse provides frequent reinforcement to the patient to get up from a chair that has arms by holding the top of the chair arm with one hand. Once the patient is standing and stable, then she can grasp either the other side of the walker or both sides of the walker. The nurse knows that this educational strategy is most effective with which type of disability?
a) Input disability
b) Perceptual disability
c) Developmental disability
d) Output disability
a) Input disability
Rationale: Reinforcement is an appropriate educational strategy with clients experiencing input disabilities. It is important to allow ample time to learn and to provide reinforcement. Individuals with output disabilities benefit from review of information. Individuals with developmental disabilities benefit from repetition of simple explanations. Individuals with perceptual disabilities benefit from highlighting of significant information for easy reference.
An example of a behavior that facilitates health includes which of the following
a) A sedentary lifestyle
b) Recreational drug use
c) Noncompliance with a medication regimen
d) Self-monitoring for signs and symptoms of illness
d) Self-monitoring for signs and symptoms of illness
Rationale: Common examples of behaviors facilitating health include self-monitoring for signs and symptoms of illness, increased daily activities and exercise, and taking prescribed medications.
A patient recently diagnosed with pancreatic cancer asks the nurse not to share the diagnosis with her family members. After visiting the patient, the patient’s daughter approaches the nurse and states, “Mom just did not seem herself today. Are biopsy reports back and do they confirm pancreatic cancer?” What is the best response from the nurse to patient’s daughter?
a) It is unethical and illegal for me to give you the biopsy results; please ask your mother.
b) It is unethical and illegal for me to discuss your mother’s medical information with you.
c) It is unethical of me to discuss biopsy results with anyone but the patient involved.
d) It is illegal for me to discuss biopsy results with anyone but the patient involved.
b) It is unethical and illegal for me to discuss your mother’s medical information with you.
Rationale: Providing a firm response in explaining the need to protect patient information is one strategy to aid the nurse in ethical decision-making. The U.S. Department of Health and Human Services (DHHS) provides for patient confidentiality. Violations of a patient’s confidentiality could result in criminal or civil litigation. While it is unethical/illegal to discuss biopsy results with the daughter, statements by the nurse indicating biopsy results are back but cannot be shared indirectly provide the daughter with confidential information. Encouraging the daughter to ask her mother about the biopsy results indirectly provides the daughter with information that the mother knows the biopsy results.
Carla, a 42-year-old patient, displays symptoms that indicate a risk for developing hypertension. As the nurse, which of the following immediate measures would you recommend for her?
a) Drug therapy
b) Patient teaching
c) Routine screening and follow-up appointments
c) Routine screening and follow-up appointments
Rationale: Because Carla is at a risk for developing hypertension, routine screening is important for early detection. Follow-up appointments should be made if she has an initial elevation in blood pressure reading in the physician’s office. Lifestyle modifications for clients with newly diagnosed primary hypertension are recommended. If the patient is diagnosed with hypertension, drug therapy can be administered, in addition to providing patient teaching.
The use of patient restraints limits which of the following ethical principles?
a) Autonomy
b) Justice
c) Beneficence
d) Trust
a) Autonomy
Rationale: It is important to weigh carefully the risk of limiting a person’s autonomy and increasing the risk of injury by using restraints against the risk of not using restraints.
Which phase of the nursing process of patient teaching ends when the strategies have been completed and when the patient’s responses to the actions have been recorded?
a) Assessment
b) Implementation
c) Evaluation
d) Planning
b) Implementation
Rationale:
The implementation phase ends when the teaching strategies have been completed and when the patient’s responses to the actions have been recorded. Assessment in the teaching-learning process is directed toward the systematic collection of data about the person’s learning needs and readiness to learn, as well as the family’s learning needs. Planning has to do with specifying the expected outcomes and assigning priorities to the diagnoses. Evaluation determines how effectively the patient has responded to teaching and to what extent the goals have been achieved.
Which of the following would be an intellectual skill used in critical thinking by nurses?
a) Supporting evidence with facts
b) Priority setting with broad time constraints
c) Determining nurse-specific outcomes
d) Utilizing bias to achieve goals
a) Supporting evidence with facts
Rationale: Intellectual skills used in critical thinking include supporting evidence with facts, priority setting with timely decision making, and determination of patient-specific outcomes. Bias is not used to achieve goals.
Which of the following statements when made by the patient indicates understanding of the Centers for Disease Control and Prevention and U.S. Preventive Services Task Force, recommendation for prostate screening frequency?
a) “I will make plans to see you every 6 months to keep an eye on my PSA levels.”
b) “I will schedule my prostate exam every 3–5 years after I am 50.”
c) “When I turn 50 I will need to have my PSA level checked every 5 years.”
d) “I will see you next year for my prostate exam.”
d) “I will see you next year for my prostate exam.”
Rationale: Prostate examinations should be done yearly. PSA levels are assessed every 1–2 years after age 50. Colonoscopy examinations are every 3–5 years
A nurse working in the emergency department (ED) reviews arterial blood gas (ABG) values for a patient diagnosed with heatstroke. Blood gas values are pH 7.48, pCO2 34, pO2 95, CO2 23, HCO2 22, and SO2 98%. Which of the following nursing interventions demonstrate the nurse’s understanding of the patient’s ABG’s and knowledge of Maslow’s hierarchy of needs when providing care for this patient?
a) The nurse completes a spiritual assessment and provides appropriate clergy support for the patient
b) The nurse immediately starts an intravenous line (IV) of dextrose 50% in a water solution (D50W)
c) Lab values are within normal limits and contacts the patient’s family to be with the patient while in the ED
d) The nurse prepares for endotracheal intubation and mechanical ventilation for the patient
d) The nurse prepares for endotracheal intubation and mechanical ventilation for the patient
Rationale: This patient is experiencing respiratory alkalosis related to heatstroke. The pH level is elevated in hyperventilation; the patient’s hyperventilation will “blow off” more CO2, leading to lower pCO2 levels. Decreased pCO2 is caused by hyperventilation. Decreased CO2 levels are seen in renal failure. Renal failure is a sign of heatstroke. With rapid breathing SO2 can be increased with deep or rapid breathing. Acute airway management is indicated to improve tissue oxygenation. Airway support meets the patient’s physiologic need for a clear airway. Spiritual support is a higher level (self-actualization) on Maslow’s hierarchy. Providing IV management for circulatory support is a basic physiologic need; however, airway management is priority.
Which of the following is an important function of accurate and thorough documentation?
a) Making judgment based on evidence
b) Involving purposeful and outcome-directed thinking
c) Providing a foundation for evaluation and quality improvement
d) Requiring knowledge, skill, and experience
c) Providing a foundation for evaluation and quality improvement
Rationale: Accurate and thorough documentation shows trends and patterns in patient status and provides a foundation for evaluation and quality improvement. In nursing, critical thinking makes judgment based on evidence. The nursing process requires knowledge, skill, and experience and involves purposeful and outcome-directed thinking.
The termination stage of the Transtheoretical Model of Change occurs when which of the following happens?
a) The person has the ability to resist relapsing back to unhealthy behavior
b) The person is not thinking about making a change
c) The person constructs a plan to change behavior
d) The person takes steps to operationalize the plan of action
a) The person has the ability to resist relapsing back to unhealthy behavior
Rationale: The termination stage of the Transtheoretical Model of Change occurs when a person has the ability to resist relapsing back to unhealthy behavior. Operationalizing a plan of action, constructing a plan to change behavior, and not thinking about making a change are not part of the termination stage
The nurse is planning a health education program for a group of high school students regarding the dangers of texting and driving. Which of the actions by the nurse illustrates the nurses understanding of health education as a primary nursing responsibility?
a) The nurse obtains the name of the school’s medical director and obtains a physician’s order to conduct the education program.
b) The nurse prepares a permission slip for all students to have signed by their parents allowing the student to participate in the educational program.
c) The nurse gathers evidenced-based information related to texting and driving and coordinates the education with the school nurse.
d) After consulting the literature and preparing the educational program, the nurse contacts the school’s medical director for approval of the planned educational program.
c) The nurse gathers evidenced-based information related to texting and driving and coordinates the education with the school nurse.
Rationale: Health education is an independent function of nursing practice and is included in all state nurse practice acts. Teaching, as a function of nursing, is included in all state nurse practice acts. As an independent nursing function a physician order or approval is not required. Health education is a primary responsibility of the nursing profession. Health education by the nurse focuses on: promoting, maintaining, and restoring health; preventing illness; and assisting people to adapt to the residual effects of illness. Prior parental consent is not required for education related to health/safety promotion.
A patient has been admitted to the health care center, diagnosed with cardiac dysfunction. The nurse notices that the patient’s ankles and feet have swollen. When the nurse uses critical thinking skills, which of the following nursing interventions does the nurse need to perform next?
a) Assess oxygen saturation level
b) Assess patient for dependent edema
c) Weigh patient daily at the same time
d) Organize activities to provide frequent rest periods
b) Assess patient for dependent edema
Rationale: Initial assessments of swollen ankles and feet are symptoms of dependent edema. Hence, the priority assessment method adopted by the nurse should be oriented towards gathering as much relevant information as possible related to edema. Taking the patient’s weight, organizing activities to provide frequent rest periods, and assessing oxygen saturation level are also nursing interventions to be used under appropriate circumstances.
